Learning from Concept Notes
At a regional meeting in June in Cambodia, participants discussed the new funding model and how to prepare a concept note.
The first ten concept notes in the new funding model were reviewed by the Technical Review Panel in June, an independent assessment of the viability of each funding application.
The panel – composed of experts in HIV, tuberculosis and malaria and in cross-cutting development issues – found some excellent applications, and others that needed more work. Some applicants were asked to make specific improvements and changes, and then submit another iteration of their application, in order to meet the standard for approval.
One of the advantages in the new funding model is the scope for feedback and revision, so that an application deemed not yet ready can be revised, and not rejected. In its first year of full implementation, the new funding model is not perfect, and will require openness on all sides to learn along the way.
As other applicants prepare their own concept notes, they may benefit from considering highlights and suggestions made by the panel, commonly known as the TRP, about what they are looking for in a concept note. An official report is scheduled for mid-July, but here is an advance summary of key recommendations made by the TRP:
Above all, the TRP looks for a clear explanation of priorities in each concept note. Strategic choices, based on evidence and national plans, are also strengthened when they draw on sub-national and sub-population epidemiological data.
Focus on interventions in specific regions and among specific populations, with funding aimed at reaching key populations or regions with highest prevalence, incidence or population at risk, is also important.
Two: Requests above allocation
Requests for funding that reach above a country’s allocation amount will be more effective when described separately in a concept note. A central element of the new funding model is moving to an allocation model where each country is informed of an amount of potential available funding.
Those countries that want to apply for an amount above the allocation should justify the request for additional interventions beyond the minimum level, such as expanding geographic coverage or expanding services. It should also rank choices with corresponding budgets and expected impact.
Special cases can be considered. It is possible that funding for those activities may be done through incentive funding, if the country is eligible, or through the register of unfunded quality demand.
Three: Health Systems Strengthening
The TRP strongly encourages applicants to commit to and weave efforts to boost health systems strengthening into their concept notes.
Ideally, Country Coordinating Mechanisms should use cross-cutting HSS interventions in more than one of the diseases to help maximize impact and they should make that connection clear in the concept note. Eligible countries are encouraged to set aside funding during the program split discussion for cross-cutting HSS, if the country has that need.
Four: Learning from previous Global Fund investments
Concept notes are stronger when applicants include an explanation of the impact of previous programs, and – most important – how lessons learned from those programs were used to reshape future investments.
Five: Concept notes should cover the period to the end of 2017
The current allocation period lasts from 2014 through 2016. However, since many concept notes will lead to grants that do not begin until 2015, many grants will last three years, from 2015 through the end of 2017.
In some cases, a CCM can discuss and get approval for a shortened grant duration of between two and three years. In those cases, the concept note should explain where funding will come from to cover the period until the end of 2017.
There are advantages to flexibility in timing, since conditions vary from country to country and disease to disease. Yet making exceptions to a three-year grant structure may require extra justification and planning.
When it comes to the nitty-gritty of filing applications for funding, many implementing partners are now able to do so online. In the new funding model, applicants can upload and submit concept notes through a new online portal.
After some early glitches, particularly with log on procedures, the new system achieved a significant level of usage in June. In the seven days between 10 June and 16 June, for instance, users from 59 countries accessed the portal, with the top users in Zimbabwe and Mongolia. Users went into the online portal 888 times during that period, with an average of 25 minutes per session.
In June, 24 Concept Notes were submitted from 23 countries, with applications for a total of more than US$2.5 billion in funding. The most widely used language was English (65 percent), with French (15 percent) and Russian (10 percent) as the next most popular languages.
Human Rights and Vulnerable Populations
A new crop of members has joined the Global Fund Human Rights Reference Group, adding a wealth of expertise from an array of different backgrounds and fields of work, from indigenous populations in Central America to LGBT groups in Africa to gender-based violence in South East Asia to harm reduction in Russia.
The Human Rights Reference Group was created to help guide the Global Fund through all matters relating to human rights and HIV, TB and malaria, both at the policy and at the operational level. Drawing on experts from the health and human rights community, the group will provide the Global Fund with practical advice on how to carry out the strategic actions identified by the Board and keeping the Global Fund abreast of emerging human rights developments at the local, national and international level that affect the response to the three diseases.
The Human Rights Reference Group is also developing new partnerships between the human rights community and the Global Fund. UNAIDS and the WHO Global TB Programme are permanent observers of the Reference Group.
A common thread ties the 15 new experts on HIV, TB, malaria and human rights: their experience working with vulnerable populations. “The people we have reached until now are what are often referred to as the low-hanging fruit, the easy to reach,” said Michaela Clayton, a lawyer and activist based in Namibia, who is director of the AIDS & Rights Alliance for Southern Africa, and co-chair of the Human Rights Reference Group. “The people we need to reach now are the key populations who are facing human rights violations.”
Clayton has worked as a human rights lawyer and HIV activist in southern and eastern Africa for 30 years, back to the very early days of the fight against the disease. “When I started working in HIV, there was no treatment in southern Africa. I remember having Christmas parties for little kids at support group meetings at home and knowing that those kids were not going to be with us next year,” she recalled. “We have come a long way since then, but I always think of those kids. We can’t leave anybody behind.”
Joanne Csete, senior program officer with Open Society Foundation’s Global Drug Policy program and a former professor at Columbia University, will also be lending her experience to the group.
As the founding director of the HIV/AIDS program at Human Rights Watch, she helped build a research program on AIDS-related human rights violations faced by women and girls, people who use drugs, prisoners, sex workers and men who have sex with men. “The focus on human rights is not worthwhile unless it means meaningful participation of people living with the diseases and those at risk in decision-making that affects them,” Csete said.
Alberto Colorado, a renowned TB patient activist, brings 15 years of experience working on TB in the US and Latin America.
Walter Flores, a social scientist in Guatemala with 20 years’ experience as an advocate for indigenous populations’ health, analyzed human rights issues in malaria this year in a paper presented to Roll Back Malaria. “Malaria is a disease that affects populations that are poor and socially excluded,” he said. “A human rights approach to malaria sees these populations as human beings who are at a disadvantage and who need our support.”
As director of the Center for the Study of Equity and Governance in Health Systems, Walter specializes in capacity building and advocacy around issues affecting indigenous populations, whose plight he calls “one of the greatest injustices of our times.” “They are human beings with expectations, dreams and life stories. My hope is to see that interventions around malaria also contribute to restore people’s dignity.”
A full list of members on the Human Rights Reference Group is on the Global Fund website.
Banking Partners in Latin America
Partners in Latin America have taken an important step towards sustainable health with an innovative partnership that brings together a regional development bank, implementers, a local radio station and the Global Fund, in support of a regional initiative aimed at eliminating malaria in Mesoamerica and Hispaniola.
With a US $200,000 contribution from the Development Bank of Latin America (known as CAF) 400 doctors and nurses in the Dominican Republic will receive training in early diagnosis and treatment of malaria, along with 120 provincial supervisors. In addition, 18,000 households in malaria-endemic areas in the Dominican Republic will be targeted in a residential-spraying program and 50 volunteers will be trained as community sprayers.
Under the agreement, the National Centre for the Control of Tropical Diseases of the Dominican Republic will provide the health training and staff, while Radio Marién – a Jesuit-run radio station on the border between the Dominican Republic and Haiti – will raise awareness about the importance of prevention and treatment of the insect-borne disease.
The CAF investment, the first of its kind, adds to a war chest of US$10 million the Global Fund approved earlier this year to galvanize efforts and funding to eliminate malaria by 2020 in Mexico, Belize, Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica, Panama, Haiti and the Dominican Republic.
For Silvio Martinelli, the Global Fund's Regional Manager for Latin America and the Caribbean, the partnership’s value goes well beyond the money. “This partnership has an enormous symbolic importance: A Latin American development bank, created by Latin America to spur sustainable development in the region, is now a stakeholder in a regional initiative,” Martinelli said “This is a great step toward long-term sustainability in the region and hopefully it will serve as a model for future contributions in other countries.”
The partnership grew out of a meeting in Davos, Switzerland, earlier this year between Enrique García Rodríguez, Executive President and CEO of CAF, and Mark Dybul, Executive Director of the Global Fund. Ana Mercedes Botero, director of Social Innovation Initiative at CAF, said the partnership is an example of pooling financial resources, expertise and local leadership. “We are tackling malaria with a development dimension and using a two-pronged approach: health and community."
CAF is a development bank made up of 18 countries as well as 14 private banks. It promotes a sustainable development model through credit operations, non-reimbursable resources, and support in the technical and financial structuring of projects in the public and private sectors of Latin America. Since 2000, cases of malaria in the Americas have been reduced drastically, achieving the Millennium Development Goal of reducing by 75 percent of malaria cases by 2015. Hispaniola, an island shared by Haiti and the Dominican Republic, is the only Caribbean island where malaria persists.